MEDICARE: DR. DIANE B. HOWIESON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	397	OR

General Provider Information

NPI Number	:	1144222381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE B. HOWIESON PH.D.

Provider Business Mailing Address
First Line	:	11322 SW RIVERWOOD RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-8447
Country	:	US
Telephone Number	:	503-636-0836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST
Second Line	:	STE 720
City	:	PORTLAND
State	:	OR
Zip	:	97205-2512
Country	:	US
Telephone Number	:	503-827-5135
Fax Number	:	503-636-8190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/09/2007

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